Safety of limb lengthening after Roux-en-Y gastric bypass: an analysis of the MBSAQIP database.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) effectively treats severe obesity, but some patients may require revisional surgery like limb lengthening (LL) for postoperative weight gain. OBJECTIVES: This study aims to compare 30-day serious complications and mortality rates between LL and primary RYGB, given limited safety data on LL. METHODS: Patients who underwent LL and RYGB were identified from the 2020 and 2021 MBSAQIP databases, the only years in which LL data were available. Baseline characteristics and 30-day rates of serious complications and mortality were analyzed. RESULTS: A total of 86,990 patients underwent RYGB and 455 underwent LL. Patients undergoing RYGB were younger (44.4 versus 49.8 yr, P < .001), had a higher body mass index (BMI) (45.5 versus 41.8 kg/m2, P < .001) and higher rates of comorbidities including diabetes (30.0 versus 13.6%, P < .001). RYGB and LL had similar operative duration (125.3 versus 123.2 min, P = .5). There were no statistical differences between cohorts for length of stay (LOS) (1.6 RYGB versus 1.6 LL d, P = .6). After LL, there were higher 30-day rates of reoperation (3.3 versus 1.9%, P = .03) and deep surgical site infections (1.3 versus .5%, P = .03) compared to RYGB. There were no differences in overall serious complications (5.1 LL versus 5.0% RYGB, P = 1.0) and mortality (.2 LL versus .1% RYGB, P = .5). Multivariable logistic regression adjustment found that previous venous thromboembolism was associated with serious complications after LL. CONCLUSIONS: When compared to primary RYGB, LL has a favorable safety profile with similar 30-day rates of serious complications and mortality.

Machine learning prediction of major adverse cardiac events after elective bariatric surgery.

BACKGROUND: Machine learning (ML) is an emerging technology with the potential to predict and improve clinical outcomes including adverse events, based on complex pattern recognition. Major adverse cardiac events (MACE) after bariatric surgery have an incidence of 0.1% but carry significant morbidity and mortality. Prior studies have investigated these events using traditional statistical methods, however, studies reporting ML for MACE prediction in bariatric surgery remain limited. As such, the objective of this study was to evaluate and compare MACE prediction models in bariatric surgery using traditional statistical methods and ML. METHODS: Cross-sectional study of the MBSAQIP database, from 2015 to 2019. A binary-outcome MACE prediction model was generated using three different modeling methods: (1) main-effects-only logistic regression, (2) neural network with a single hidden layer, and (3) XGBoost model with a max depth of 3. The same set of predictor variables and random split of the total data (50/50) were used to train and validate each model. Overall performance was compared based on the area under the receiver operating curve (AUC). RESULTS: A total of 755,506 patients were included, of which 0.1% experienced MACE. Of the total sample, 79.6% were female, 47.8% had hypertension, 26.2% had diabetes, 23.7% had hyperlipidemia, 8.4% used tobacco within 1 year, 1.9% had previous percutaneous cardiac intervention, 1.2% had a history of myocardial infarction, 1.1% had previous cardiac surgery, and 0.6% had renal insufficiency. The AUC for the three different MACE prediction models was: 0.790 for logistic regression, 0.798 for neural network and 0.787 for XGBoost. While the AUC implies similar discriminant function, the risk prediction histogram for the neural network shifted in a smoother fashion. CONCLUSION: The ML models developed achieved good discriminant function in predicting MACE. ML can help clinicians with patient selection and identify individuals who may be at elevated risk for MACE after bariatric surgery.

Hiatal hernia repair after previous laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Symptomatic hiatal hernia (HH) with pouch migration after previous laparoscopic Roux-en-Y gastric bypass (RYGB) is an uncommon complication, with limited extant evidence for the utility of surgical repair. OBJECTIVE: To evaluate the presentation and resolution of symptoms in patients with HH repair after previous RYGB. SETTING: Multicenter University Hospital. METHODS: A retrospective review was conducted from 2010 to 2022. Patients with prior RYGB who were undergoing subsequent isolated HH repair were included. Patients undergoing incidental HH repair during concomitant revisional bariatric surgery were excluded. Baseline characteristics and surgical outcomes were evaluated and presented as medians (25th-75th percentile). RESULTS: Forty-four patients met the inclusion criteria. The time from RYGB to HH repair was 59 months (39-88). Body mass index at HH repair was 31 kg/m2 (27-39). The most common presenting symptoms of hernia were dysphagia (52%), gastric reflux (39%), and abdominal pain (36%). All HH repairs were completed with a minimally invasive approach (98% laparoscopic, 2% robotic). Nonabsorbable suture was used in 98% of patients, with bioabsorbable mesh in 30%. At a median 28-day (12-117) follow-up, 70% of patients reported full symptom resolution and 23% partial resolution. At follow-up, 2 patients had radiologic HH recurrence, with 1 requiring reoperation. CONCLUSIONS: This is the largest series of isolated HH repair for symptomatic pouch migration after previous RYGB. Common presenting symptoms are dysphagia and reflux, and surgical repair yields a high rate of symptom resolution in the short term. Longer follow-up is needed to evaluate the durability of this intervention.

Primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus sleeve gastrectomy to SADI conversions: a comparison study of prevalence and safety.

BACKGROUND: Conversion from sleeve gastrectomy (SG) to single anastomosis duodeno-ileal bypass (SADI) is becoming increasingly common, but data regarding safety is of these conversions is scarce. As such, the objective of this study was to compare the 30-day rate of serious complications and mortality of primary SADI (p-SADI-S) with SG to SADI (SG-SADI) conversions. METHODS: This retrospective cohort study analyzed the MBSAQIP database. Patients undergoing p-SADI-S and SG-SADI were included. Data collection was limited to 2020 and 2021. A multivariable logistic regression analysis was performed between groups to determine if SG-SADI was an independent predictor of 30-day serious complications or mortality. RESULTS: A total of 783 patients were included in this study, 488 (62.3%) underwent p-SADI-S and 295 (37.6%) underwent SG-SADI. The mean body mass index (BMI) at the time of surgery was lower in the SG-SADI cohort (45.1 vs 51.4 kg/m2, p < 0.001). Indications for revision in the SG-SADI cohort included weight recurrence (50.8%), inadequate weight loss (41.0%), other (3.0%), GERD (2.7%), and persistent comorbidities (2.5%). SG-SADI had longer operative times (156.7 vs 142.1 min, p < 0.001) and was not associated with a higher rate of serious complications (5.7 vs 6.9%, p = 0.508) compared to p-SADI-S. p-SADI-S was associated with a higher rate of pneumonia (1.2 vs 0.0%, p < 0.001), and SG-SADI was not correlated with higher rates of reoperation (3.0 vs 3.2%, p = 0.861), readmission (5.4 vs 5.5%, p = 0.948) and death (0.0 vs 0.2%, p = 0.437). On multivariable analysis, SG-SADI was not independently predictive of serious complications (OR 0.81, 95% CI 0.43 to 1.52, p = 0.514) when adjusting for age, sex, BMI, comorbidities, and operative time. CONCLUSIONS: The prevalence of SG-SADI is high, representing 37.6% of SADI-S procedures. Conversion from sleeve to SADI, is safe, and as opposed to other studies of revisional bariatric surgery, has similar 30-day complication rates to primary SADI-S.

Presence of SARS-CoV-2 in abdominal tissues and biologic fluids during abdominal surgery: a systematic review.

BACKGROUND: Viral transmission to healthcare providers during surgical procedures was a major concern at the outset of the COVID-19 pandemic. The presence of the severe acute respiratory disease syndrome coronavirus (SARS-CoV-2), the virus responsible for COVID-19, in the abdominal cavity as well as in other abdominal tissues which surgeons are exposed has been investigated in several studies. The aim of the present systematic review was to analyze if the virus can be identify in the abdominal cavity. METHODS: We performed a systematic review to identify relevant studies regarding the presence of SARS-CoV-2 in abdominal tissues or fluids. Number of patients included as well as patient's characteristics, type of procedures, samples and number of positive samples were analyzed. RESULTS: A total of 36 studies were included (18 case series and 18 case reports). There were 357 samples for detection of SARS-CoV-2, obtained from 295 individuals. A total of 21 samples tested positive for SARS-CoV-2 (5.9%). Positive samples were more frequently encountered in patients with severe COVID-19 (37.5% vs 3.8%, p < 0.001). No health-care provider related infections were reported. CONCLUSION: Although a rare occurrence, SARS-CoV-2 can be found in the abdominal tissues and fluids. It seems that the presence of the virus in the abdominal tissues or fluids is more likely in patients with severe disease. Protective measures should be employed in the operating room to protect the staff when operating patients with COVID-19.

A nationwide analysis of median arcuate ligament release between 2010 and 2020: a NSQIP Study.

BACKGROUND: Median arcuate ligament syndrome is a rare disease with overlapping symptoms of broad foregut pathology. Appropriately selected patients can benefit from a laparoscopic or open median arcuate ligament release. Institutional series have reported the outcomes of open and laparoscopic techniques but there are no nationwide analysis comparing both techniques and overall trends in treatment. METHODS: Cross-sectional study using the American College of Surgeons-National Surgical Quality Improvement Project from 2010 to 2020. Celiac artery compression syndrome cases were identified by International Classification of Diseases (ICD) codes and categorized as open or laparoscopic. Trends in the use of each technique and 30-day complications were compared between the groups. RESULTS: A total of 578 open cases (76%) and 185 laparoscopic cases (24%) were identified. There was an increase adoption of the laparoscopic approach, with 22% of the cases employing this technique at the end of the study period, compared to 7% at the beginning of the study period. The open group had a higher prevalence of hypertension (26% vs 18%, p = 0.04) and bleeding disorders (5% vs 2%, p 0.03). Laparoscopic approach had a shorter length of stay (2.3 days vs 5.2 days, p < 0.0001), lower major complication rates (0.5% vs 4.0%, p = 0.02) and lower reoperation rates (0% vs 2.6%, p = 0.03). Overall mortality was 0.1%. CONCLUSION: Overall numbers of surgical intervention for treatment of median arcuate ligament increased during this timeframe, as well as increased utilization of the laparoscopic approach. It appears to be an overall safe procedure, offering lower rates of complications and shorter length of stay.

Infarto esplénico como complicación de gastrectomía vertical laparoscópica. Reporte de caso / Splenic infarction as a complication of laparoscopic vertical gastrectomy. Case report

La gastrectomía vertical laparoscópica es actualmente la cirugía bariátrica más empleada a nivel mundial. Aunque es un procedimiento seguro y efectivo pueden ocurrir complicaciones mayores. En el presente trabajo reportamos el caso de un infarto y absceso esplénico como una rara complicación de esta técnica, que requirió finalmente de esplenectomía como tratamiento definitivo. Caso clínico: Mujer de 22 años con obesidad grado I, a quien se le practicó gastrectomía vertical laparoscópica con buena evolución intrahospitalaria y egreso a las 48 horas. Al 4to día posoperatorio consultó por fiebre, dolor abdominal, taquipnea y taquicardia. Mediante tomografía computada de abdomen se diagnosticó infarto esplénico parcial. Recibió tratamiento médico con remisión inicial de los síntomas, los cuales reaparecieron a la 3era semana. Se reinició el tratamiento médico, esta vez sin respuesta, y con evolución al absceso esplénico. Se decidió esplenectomía como tratamiento definitivo logrando la recuperación completa de la paciente. Conclusión: El infarto esplénico es una complicación infrecuente de la gastrectomía vertical. Su tratamiento inicial es médico, reservando la esplenectomía para los casos que no responden(AU)

Laparoscopic sleeve gastrectomy is currently the most performed bariatric surgery worldwide. Although it is an effective and safe procedure major complications can occur. In the present manuscript we report a case of splenic infarct and abscess as a rare complication of laparoscopic sleeve gastrectomy, finally requiring a splenectomy as a definitive treatment. Case report: A 22 years old woman with grade I obesity underwent laparoscopic sleeve gastrectomy with good hospital evolution and 48 hours discharge. On the 4th postoperative day she return because fever, abdominal pain, tachypnea and tachycardia. By means of a computed tomography a splenic infarct was diagnosed. She received medical treatment with initial remission of symptoms, which reappear at the third week. Medical treatment was restarted, this time without success, and with progression to splenic abscess. We decided a splenectomy as definitive treatment achieving a complete patient recovery. Conclusion: Splenic infarction is a rare complication after sleeve gastrectomy. The treatment is non surgical, reserving the splenectomy for the non responded cases(AU)

Results of The Comparative Study of 200 Cases: One Anastomosis Gastric Bypass vs Roux-en-Y Gastric Bypass.

INTRODUCTION: Obesity has experienced worldwide increase and surgery has become the treatment that has achieved the best results. Several techniques have been described; the most popular are vertical gastrectomy (GV) and the Roux-en-Y gastric bypass (RYGB). However, mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB) has gained popularity due to its simplicity and good results. OBJECTIVE: To comparatively evaluate the results of MGB/OAGB with those of RYGB with 1-year follow-up. METHODS: The paper presents a comparative case and control study of 100 patients that underwent MGB/OAGB surgery and another 100 with RYGB surgery, operated between 2008 and 2016. Patients were not submitted to revision surgery and had the following pre-operative variables: age 40.46 ± 12.4 vs. 39.43 ± 10.33 years; sex 64 and 54 women, 36 and 46 men; BMI 44.8 ± 12.06 and 45.29 ± 8.82 kg/m2; 50 and 54 cases with comorbidities, respectively, these being non-significant differences. RESULTS: The surgical time was 69.01 ± 4.62 (OAGB) vs. 88.98 ± 3.44 min; the time of hospitalization was 2 days, reaching a BMI of 27.7 ± 7.85 and 29 ± 4.52 kg/m2, with an excess weight loss 1 year after surgery of 89.4 vs. 85.9%, respectively. The morbidity rates are 9% for OAGB and 11% for the RYGB. There was a comorbidity resolution of 84.4 and 83.7% respectively, without mortality. CONCLUSIONS: The results show the benefits of both techniques, OAGB being the easiest to perform and with less surgical time.

Laparoscopic technique for hernia reduction and mesenteric defect closure in patients with internal hernia as a postoperative complication of laparoscopic Roux-en-Y gastric bypass.

Internal hernia is a relatively common complication of laparoscopic Roux-en-Y gastric bypass. Laparoscopic treatment may be a challenge for nonbariatric surgeons if small-bowel obstruction is present. The aim of this paper is to present a systematic laparoscopic technique for hernia reduction and mesenteric defect closure in patients with small-bowel obstruction due to an internal hernia as a postoperative complication of laparoscopic Roux-en-Y gastric bypass. From February 2007 to May 2011, this technique was used in 41 consecutive patients. One case was converted to an open approach due to extensive bowel necrosis. There were no complications related to the technique but 2 patients suffered pulmonary aspiration during anesthesia. After the internal hernia repair patients reported no further abdominal symptoms. Treatment of small-bowel obstruction due to an internal hernia should be attempted by laparoscopy except in the setting of bowel necrosis. The technique presented in this article represents a safe and effective option for the management of this complication.

Gastrectomía vertical laparoscópica: estudio del vaciamiento gástrico / Laparoscopic vertical gastrectomy: study of gastric emptying

Establecer el rango de valores de vaciamiento gástrico determinado por método fluoroscópico, en pacientes sometidos a gastrectomia vertical laparoscópica (GVL), en la Unidad de Cirugía Endoscópica, Servicio de Cirugía II, Hospital Universitario de Caracas. Estudio prospectivo, descriptivo, realizado entre enero y octubre de 2010 en catorce pacientes obesos con indicación de GVL, que aceptaron participar en la investigación. La edad promedio fue de 38,5 años. De los catorce pacientes estudiados trece eran mujeres. La media del índice de masa corporal (IMC) en el preoperatorio fue 38,8 kg/m² y en el posoperatorio 32.7 kg/m² (p-0,001). La media del porcentaje del vaciamiento gástrico a los 30 minutos en el preoperatorio fue 66,4% y en el posoperatorio 89.9 (p-0.033). La media del volumen gástrico en el preoperatorio fue 440.8 ml y en el posoperatorio 138.1 ml, con una capacidad gástrica final de 31.3%, (p=0.00061). Se observó un vaciamiento gástrico acelerado para líquidos después de la GVL, los mecanismos pudieran ser: modificación en la anatomía funcional; reducción en la función de reservorio, alteración del complejo antro-duodenal, y/o modificaciones hormonales gastrointestinales. Es pertinente desarrollar estudios prospectivos con mayor casuística para verificar que nuestros resultados puedan ser reproducidos.

To establish the range of values for gastric emptying by fluoroscopic method, in patients submitted to laparoscopic sleeve gastrectomy (LSG), at the Endoscopic Surgery Unit, Surgery II Service, Hospital Universitario de Caracas. Prospective, descriptive study performed between January and October 2010 in fourteen obese patients with indication of LSG who approved to participate in the investigation. Mean age was 38.5 years. Of fourteen patients thirteen were female. Mean preoperative body mass index (BMI) was 38,8 kg/m² and postoperative it was 32,7 kg/m² (p=0.001). Mean percentage of preoperative gastric emptying at 30 minutes was 66.4% and postoperative it was 89.9% (p=0.033). Mean of preoperative gastric volume was 440.8 ml and postoperative it was 138.1 ml, with a final gastric capacity of 31.3% (p=0.0006). A faster gastric emptying for liquids after LSG was observed, the mechanisms could be: functional anatomy modifications; a reduction in the reservoir function; antral-duodenal complex alterations, and/or gastrointestinal hormonal changes. Is relevant to develop prospective studies with more casuistic to verify that our results can be reproduced.

Laparoscopic sleeve gastrectomy with duodenojejunal bypass for the treatment of type 2 diabetes in non-obese patients: technique and preliminary results.

BACKGROUND: Medical treatment of type 2 diabetes has often insufficient clinical results at long term. Although the surgical option is a well-established alternative for obese patients, the procedures in non-obese are currently being developed. METHODS: A 12-month prospective trial with ten diabetic non-obese patients who underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass is presented. Changes in fasting blood glucose, HbA1c, weight, and BMI were determined. RESULTS: There was a significant reduction in fasting glycemia and HbA1c at 1 year postoperative (p < 0.004). One patient had an intra-abdominal bleeding and a wound infection treated with blood transfusion and antibiotic therapy, respectively. The BMI decreased 12.1% and in any case it was reduced to less than 20 kg/m². CONCLUSIONS: Laparoscopic sleeve gastrectomy with duodenojejunal bypass is a promising procedure for the treatment of non-obese patients with type 2 diabetes. Studies with large number of patients and longer follow-up are necessary to make definitive conclusions.

Calidad de vida en pacientes obesos sometidos a bypass gástrico laparoscópico en "Y" de Roux y gastrectomía vertical laparoscópica / Quality of life in obese patients undergoing laparoscopic gastric bypass

El presente es un estudio prospectivo en el que se evalúan los cambios en la calidad de vida y tolerancia a los alimentos en pacientes con obesidad mórbida, luego de bypass gástrico en "Y" de Roux (BPGYR) y gastrectomía vertical (GV) por laparoscopia, en el Servicio de Cirugía II del Hospital Universitario de Caracas. Desde septiembre de 2008 hasta enero de 2009 se incluyeron de manera prospectiva, no aleatoria, 41 pacientes; 23 sometidos a BGYR y 18 a GV por laparoscopia. Se aplicaron los test de calidad de vida de Moorehead-Ardelt, y el de calidad de alimentación de Suter, a los 3, 6 y 9 meses de posoperatorio. La pérdida del exceso de peso fue satisfactoria para ambos procedimientos, siendo de 60 por ciento para el BGYR y de 71,5 por ciento para la GV. En ambos grupos hubo mejoría estadísticamente significativa (P < 0,01) de la calidad de vida con respecto al preoperatorio, presentando todos los pacientes un puntaje correspondiente a calidad buena o muy buena a los 9 meses del posoperatorio. La tolerancia a los alimentos se vió disminuida a los 3 meses posquirúrgicos en ambas técnicas, con recuperación posterior a los 6 y 9 meses, siendo mejor en el grupo sometido a GV (P< 0,05). Se concluye que ambas técnicas son efectivas, y mejoran la calidad de vida de los pacientes con obesidad mórbida. Hay un deterioro temporal de la tolerancia a los alimentos y calidad de alimentación, que se recupera progresivamente con mejor respuesta a los 9 meses en los pacientes sometidos a GV

The following is a prospective study that evaluate the quality of life and food tolerance changes in patients submitted to Roux en "Y" gastric bypass and sleeve gastrectomy by laparoscopy, at Servicio de Cirugía II of the Hospital Universitario de Caracas. From september 2008 to january 2009, 41 patients were included in a prospective, non randomized way; 23 submitted to Roux en "Y" gastric bypass and 18 to sleeve gastrectomy by laparoscopy. The Moorehead-Ardelt quality of life, and Suter food tolerance tests were applied at 3, 6 and 9 postoperative months. The excess weight loss was statistically satisfactory (P< 0.01) for both procedures, 60 percent for Roux en "Y" gastric bypass and 71.5 percent for sleeve gastrectomy. For both groups there was statistically significant improve (P< 0.01) in quality of life related to the preoperative period, with all patients on good and very good quality of life at 9 months. Food tolerance was worsened at 3 months postsurgery in both techniques, with progressive recovery at 6 and 9 months, doing better the GV group (P< 0.05). We conclude that both techniques are effective, and improve the quality of life of morbidly obese patients. There is a temporary worsening in food tolerance that is progressively recovered with better response at 9 months in patients submitted to sleeve gastrectomy

Modificación de la técnica abierta para el neumoperitoneo en cirugía bariátrica por laparoscopia

Se presenta una modificación a la técnica original de acceso abierto para la creación del neumoperitoneo, en pacientes con obesidad clínicamente severa sometidos a cirugía laparoscópica

We present a modification of the original technique for open access to create a pneumoperitoneum, in patients with clinically severe obesity who underwent laparoscopic surgery

Treatment of urachal anomalies: a minimally invasive surgery technique.

BACKGROUND: Urachal disease is uncommon. The surgical treatment consists of the resection of the urachus throughout its entire length. Our objective is to demonstrate the use of minimally invasive surgery to treat this disease. METHODS: Six patients were studied and diagnosed. The technique used three 10-mm ports on the right hemi abdomen, through which the dissection of the urachus was performed from the umbilical extreme to the bladder. We evaluated the perioperative records to assess morbidity and outcome. RESULTS: Most patients suffered from episodes of umbilical discharge. The diagnosis was made mainly through clinical history and confirmed during the laparoscopic procedure. The urachus was resected throughout its entire length, and we did not perform a segmentary bladder resection in any patient. The average operative time was 66 minutes (range, 42 to 123), and no operative complications were associated with the technique. DISCUSSION: Minimally invasive surgery is a safe and effective procedure that allows the dissection of the urachus through its entire length, providing optimal postoperative results.

Abordaje laparoscópico de la úlcera duodenal perforada / Laparoscopic approach to the perforated gastroduodenal ulcer

Presentamos nuestra experiencia con el abordaje laparoscópico en 7 pacientes consecutivos con diagnóstico clínico de úlcera gastroduodenal perforada. En todos los casos se utilizó la técnica de cierre simple a puntos separados más parches de epiplón, con lavado y drenaje peritoneal. Se convirtieron dos pacientes a cirugía abierta debido a úlceras posteriores. En los cincos pacientes completados por laparoscopia se obtuvo un tiempo quirúrgico de hospitalización promedio de 80 minutos (45`- 120`) y 5 días respectivamente (3 a 8 días). La morbilidad fue de una paciente la cual presentó descarga purulenta a través del drenaje abdominal que se resolvió por esta vía junto con la administración de antibióticos orales. No hubo mortalidad en la serie. Estos resultados muestran que esta técnica representa un excelente abordaje para la úlcera duodenal perforada y debería ser el método estándar de tratamiento en estos casos

Cirugía endoscópica mínimamente invasiva de la glándula tiroides en perros / Manimaly invasive endoscopic surgery of the thyroid gland in dogs

El objetivo de este trabajo consistió en desarrollar la técnica de cirugía endoscópica mínimamente invasiva de la glándula tiroides en perros para desarrollar destrezas, habilidades e innovaciones quirúrgicas con miras a crear un modelo experimental. Se realizó un estudio de carácter experimental en perros donde se desarrolló la técnica quirúrgica endoscópica mínimamente invasiva de la glándula tiroides. Se realizó cirugía endoscópica del lóbulo derecho de la glándula tiroides derecha a 7 perros mestizos eutróficos. El peso promedio de la muestra fue de 12,43 Kg (12-15,4 Kg). El tiempo operatorio fue en promedio de 169,29 minutos. Se logró realizar la disección roma cervical endoscópica en los 7 animales. En 6 de los animales se abordó el espacio pretraqueal y celda tiroidea sin complicaciones. Hubo sangrado intraoperatorio importante (mayor de 10 mL) en un perro y conversión al procedimiento abierto en solamente uno. Las complicaciones que se presentaron fueron enfisema saubcutáneo en un caso hematoma posoperatorio en otro perro. El perro presentó el enfisema subcutáneo masivo falleció en el posoperatorio inmediato. En conclusión la técnica mínimamente invasiva de la cirugía endoscópica de la glándula tiroides en perros constituye un modelo experimental seguro, factible y adecuado para el desarrollo destrezas en la disección cervical endoscópica

Safenectomía endoscópica en pacientes con insuficiencia de safena magna / Endoscopic saphenectomy in patients with saphena magna's insufficiency

Entre marzo de 1999 y octubre de 2001 en la unidad de Cirugía Endoscópica del Servicio de Cirugía II en el Hospital Universitario de Caracas, se realizó un estudio con el objetivo primordial de describir la técnica quirúrgica para safenectomía endoscópica en pacientes con insuficiencia de safena magna. Se evaluó además, el tiempo operatorio, las complicaciones posoperatorias y la conformidad del paciente con la técnica realizada, comparando el uso de anestesia troncular versus epidural. El promedio de tiempo quirúrgico fue de 62,5 minutos para el grupo A y de 87 para el B. El 83 por ciento de los pacientes tuvo un dolor posoperatorio clasificado como bajo en el grupo A y 90 por ciento en el B. Se convirtió un paciente a cirugía abierta (5,88 por ciento). Hubo dos casos de linforragia (12,5 por ciento) ambos en el grupo A y obesos y tres equimosis (uno distal en el A y dos proximales en el B), no hubo infecciones y el 90 por ciento de los pacientes se mostraron conformes con el procedimiento. La safenectomía endoscópica con anestesia troncular es un excelente procedimiento para el tratamiento quirúrgico de los pacientes con insuficiencia de safena magna seleccionados, bien tolerada y con bajo índice de complicaciones

Implicaciones clínicas y terapéuticas de los cambios manométricos del esfínter esofágico inferior luego de funduplicaturas laparoscópicas / Clinical and therapeutic implications of the manometric changes on the lower esophagic sphincter after laparoscopic fundoaplication

El presente trabajo tuvo como finalidad determinar los cambios manométricos que se generan en el esfínter esofágico inferior luego de funduplicaturas laparoscópicas totales y parciales, en pacientes con enfermedad por reflujo gastroesofágico, acalasia y hernia paraesofágica gigante; así como establecer la relación de dichos cambios con el control de la enfermedad y las complicaciones posoperatorias. De 42 pacientes sometidos a estos procedimientos, se incluyen en el estudio 28 casos (5 Nissen, 19 Toupet y 4 Dor) en quienes se práctico manometría esofágica a las 8 semanas del posoperatorio. En los tipos de funduplicatura se observaron aumentos estadísticamente significativos de la presión del esfínter esofágico inferior (test de Wilcoxon), sin embargo, no hubo diferencias al comparar los grupos entre sí. Todos los pacientes con funduplicatura de Nissen presentaron disfagia posoperatoria, lo cual no ocurrió en ninguno de los casos con funduplicaturas paraciales. Un paciente con funduplicatura de Toupet presentó recidiva de los síntomas a los dos años de operado debido al deslizamiento de la válvula hacia el mediastino. Esto requirió de nueva cirugía antirreflujo practicada con éxito por laparoscopia. todos los demás pacientes presentan control adecuado del reflujo sin medicación

Cura operatoria por laparoscopia de hernia paraesofágica gigante / Laparoscopic surgical of gigantic paraesophageal hernia

Las hernias paraesofágicas representan el 5 por ciento de los defectos del hiato esofágico y la reparación quirúrgica de las mismas constituye el único tratamiento definitivo disponible. En el presente trabajo se describe una técnica laparoscópica para la corrección de la hernia paraesofágica gigante utilizada en dos pacientes con bueno resultados. Se discuten los tipos de reparación descritos en la literatura haciendo énfasis en los aspectos técnicos controversiales que presenta esta cirugía

Biopsia intestinal asistida por la laparoscopia como método diagnóstico en una paciente con enteritis eosinofília / Intestinal biopsy assisted by laparoscopy as a diagnostic method in a patient with eosinophilic enteritis

El objetivo del siguiente trabajo es presentar una técnica laparoscópica para la biopsia de intestino delgado, la cual permitió realizar un diagnóstico específico (enteritis eosinofílica) en una paciente con dolor abdominal de etiología incierta. Se describe el caso de una paciente de 23 años con cuadro clínico de dolor adbominal y estudios radiológicos no concluyentes para el diagnóstico. Bajo anestesia general se realiza laparoscopia diagnóstica y biopsia yeyunal de espesor total mediante una técnica asistida, con enterorrafia extracorpórea en dos planos. Se concluye que la laparoscopia puede ser un método valioso en el diagnóstico de los pacientes con patologías intestiales inflamatorias, ya que permite realizar biopsia dirigidas mediantes técnicas sencillas con mínima morbilidad